The number of electronic cardiac devices, including pacemakers and cardioverter-defibrillators, being implanted each year is increasing. As a result, there has been a 210% increase in the incidence of device infection between 1993 and 2008 in the United States. Cardiac device infective endocarditis (CDIE) is significant in that it is associated with a higher mortality rate than device infection without endocarditis.
Athan et al. examined prospective data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), collected from 61 centers in 28 countries over a six year period. All patients were hospitalised adults with definite endocarditis as defined by the modified Duke endocarditis criteria. The authors examined in-hospital and 1-year mortality.
CDIE was diagnosed in 6.4% of patients with definite infective endocarditis. CDIE generally occurred in older patients (median age, 71.2 years), was caused by staphylococci (66.6% of patients), and was associated with contact with health care services (45.8%). 37.3% of patients also had co-existing valve involvement (especially the tricuspid valve). In-hospital and one-year mortality rates were 14.7% and 23.2%, respectively. Removal of the device was associated with an increased chance of survival at one year (hazard ratio 0.42 when compared to patients who did not undergo device removal).
Patients with cardiac device infective endocarditis have high rates of mortality and concomitant valve infection. Early device removal is indicated to improve survival at one year.
- Athan E, Chu VH, Tattevin P et al. Clinical Characteristics and Outcome of Infective Endocarditis Involving Implantable Cardiac Devices. JAMA 2012;307:1727-1735.